Overview

High definition video conferencing makes for much faster and more effective diagnosis of stroke patients

When Victoria Oatham suffered a stroke, a senior consultant was on hand to ensure she got the right treatment. Yet, remarkably, he was nowhere near the Royal Surrey County Hospital where she was admitted.

At home in his study 20 miles away, Adrian Blight was able to assess Victoria’s condition using BT high definition video conferencing. He spoke to and observed Victoria, and studied a scan of her brain.

Urgent treatment was needed and Adrian prescribed clot-busting drugs. Feeling returned to Victoria’s left leg within hours. Two days later she was up and about, with a full recovery in prospect. Technology really can have a life changing impact.

With a stroke, it’s really important that you get prompt treatment. Without this system it would definitely have taken longer.”-Victoria Oatham, Patient, Royal Surrey County Hospital

NHS Surrey

3:05

Watch this three minute video to learn how the Surrey Telestroke service is offering centralised out-of-hours stroke assessment using high definition (HD) video conferencing technology.

Challenge

Every year around 1,800 patients attend Surrey accident and emergency (A&E) units with suspected strokes. Rapid assessment and correct diagnosis is vital and means the difference between life and death. A stroke is caused by a blocked blood vessel which can be effectively treated with a clot-busting drug, but if that were given to a patient with a brain haemorrhage bleeding would increase.

Time is critical when treating strokes,” explains Adrian Blight, Surrey Telestroke clinical director and the lead consultant for stroke medicine at the Royal Surrey County Hospital. “For the best chance of recovery a patient needs to be diagnosed and treated within four hours.” However, clinical assessment of patients potentially with stroke is a specialised area. Adrian continues: “Face-to-face assessment is vital, but out-of-hours a senior consultant with the necessary skills would not always be onsite.”

Although hospitals in Surrey had various on-call arrangements, many found it difficult to cover 24/7 rotas with the resources available. In addition consultants needed to travel to the hospital to assess patients, losing time in those vital early moments following a stroke. Research has shown that patients with conditions such as stroke admitted out-of-hours are more likely to die, to a large extent due to the unavailability of senior doctors.

Adrian and fellow clinicians across Surrey had a vision. He engaged with colleagues in the Surrey Heart and Stroke Network, local IT specialists, and the N3 Service Provider (N3SP) team to explore the possibilities.

Solution

The Surrey N3-based Community of Interest Network (COIN) replaced multiple N3 connections in the region with a single resilient solution encompassing inter-site networking, security, and access to the core N3 network. As well as providing higher bandwidth connectivity, the COIN delivers the technical capability to securely share applications and data, such as Picture Archiving and Communication System (PACS) images from any N3-connected site or remote location with broadband access.

Following Adrian’s lead, five hospitals in and around Surrey joined forces to create a centralised out-of-hours stroke assessment service using high definition (HD) video conferencing technology over the Surrey COIN. It uses two trolley-mounted video conferencing units at each of the region’s five acute hospitals: one in the A&E department, and the other in the stroke unit to enable patient monitoring.

The trolleys are equipped with video conferencing units, HD cameras, microphones, and screens. Connected via wireless broadband to the Surrey COIN, a centralised server runs the Polycom Converged Management Application software. Wherever the consultant may be, a client application installed on their laptop enables connection to the bedside via a secure broadband link.

Colin Lee, senior project manager at National Health Service (NHS) Surrey, who oversaw implementation of the Telestroke project, says: “Implementation proved to be technically challenging, but working closely with the N3 team everyone pulled together to overcome any difficulties as they arose. We’re very pleased with the results. The project’s probably been one of the most satisfying that I’ve worked on.”

Value

Being able to work remotely is enabling fast diagnosis and effective treatment of Surrey stroke patients at any time of the day or night.

I can review scans and test results online, see and talk with the patient over the HD video link, and speak face-to-face with the onsite medical team and worried family members – all without leaving my home office,” says Adrian Blight. “Many conditions masquerade as a stroke. Being able to thoroughly assess patients more rapidly and prescribe the right treatment saves lives and improves the chance of a full recovery.”

The Telestroke service has proved its value and is now fully launched across all five sites. Initially deployed as a proof-of-concept trial at the Royal Surrey County Hospital, this is the first use of a potential N3 reservationless video conferencing service. The Surrey results are impressive. During the first few months the Telestroke service has been used 50 times with 20 clot-busting treatments administered.

One such instance was 20-year-old Victoria Oatham who was rushed to the Royal Surrey County Hospital having suffered a stroke at home. Adrian Blight was at her side within seconds, in a virtual sense, despite being at home 20 miles away.

With a stroke, it’s really important that you get prompt treatment,” recalls Victoria. “Without this system it would definitely have taken longer.” Adrian’s fast clot-busting treatment saw a full recovery in prospect; feeling returned to Victoria’s left leg within hours.

Aside from the obvious advantages for patients, the Telestroke service offers efficiency benefits for NHS Surrey too. A single on-call consultant can now cover all five hospitals and make far more productive use of their time through avoiding travel. There are further benefits from ambulance travel time and costs, less carbon emissions, and reduced ongoing care costs from improved patient outcomes.

There are nine senior consultants on the Surrey rota,” confirms Adrian Blight. “The N3-enabled Telestroke service has reduced the burden on each of us and it’s proving to be a practical and cost effective way to provide a fast response for stroke patients.”

The Surrey hospitals are continuing to refine Telestroke processes and are considering extending its use to the assessment of patients suspected of a transient ischaemic attack, often referred to as a mini-stroke. The Surrey experience is providing valuable input and helping refine processes for other initiatives such as N3 Telehealth. Equally, reservationless video conferencing could have applications in other fields, such as the assessment of people with trauma or for monitoring patients during rehabilitation.

Adrian Blight concludes: “Early diagnosis enables treatment plans to be determined more quickly, enabling a better outcome for everyone.” Colin Lee sums up the financial benefits: “NHS estimates suggest that care costs for each stroke patient average £60,000 over ten years. By improving patient clinical outcomes the Telestroke service will be a major contributor to NHS cost savings.”

In fact, Surrey has increased the number of patients receiving clot-busting treatment from 15 per cent to 20 per cent based on a total of 1,800 patients per year. That means that 90 more patients are getting this treatment and do not require lots of ongoing treatment. Working back from Colin Lee’s 10-year per-patient figure, that clinical improvement equates to an annual saving of £540,000.